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17 Cards in this Set
- Front
- Back
Acute Renal Failure
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ARF is a rapid deterioration or cessation in kidney function demonstrated by progressive azotemia and serum creatinine. Anuria, oliguria, or polyuria may exist.
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ARF: review renal function
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*regulate fluid volume(edematous, ^wt, CHF, SOB, rales)
*regulate electrolyte balance (^K, <Ca, ^Phos) *Regluate acid-base balance (lungs ^ or <R 1 hr)(kidneys ^<UO 24hrs) *regluate BP (renin-angio: vasoconstriction=<BP)(aldosterone ^NA, ^H2O, ^Bl vol) *excrete nitrogenous waste products (^BUN) *produce erythropoietin (anemic <dec RBC) *Metabolism of vitD (bones) |
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ARF: risks for development
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*Hx DM, HTN, CV disease, calculi
*Family hx calculi, HTN *drugs with potential for nephrotoxicity (gentomycin, amphoteracin, NSAIDS, chemo) *major trauma, crushing injuries, severe allergic reactions |
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ARF: hyperkalemia
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*Kalexalate enema, po
*sorbitol retention enema *D50W with Humulin R insulin *Soium Bicarbonate IV *IV calcium gluconate *dialysis |
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ARF: dietary changes
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*restrict protein
*high CHO, fat *restrict fluids *restrict Na *restrict K |
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ARF: medications
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*diuretics: lasix, bumex, mannitol
*Aluminum hydroxide preparations (AlternaGel) binds with Phosphate *Calcium replacement *epogen/iron supplements |
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Causes of ARF
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*prerenal: <blood flow to the kidney
*intrarenal: direct damage to the kidney parenchyma *postrenal: obstruction to the flow of urine which may cause hydronephrosis |
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Causes of Prerenal ARF
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*inadequate intravascular volume (fluid loss from N/V; hemorrhage, excessive diuresis)
*Redistribution of blood volume (peripheral vasodilation, third spacing) *reduced CO (acute MI--> cardiogenic shock) *renal artery thrombosis |
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Causes of Intrarenal ARF
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*ATN most common form
*prolonged ischemic damage *nephrotoxic damage (radiographic contrast dye, drugs: antibiotics, NSAIDS, heavy metals) *glomerulonephritis |
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Causes of Postrenal ARF
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*Obstruction due to
-calculi -blood clots -BPH -Obstruction of indwelling catheter -tumors |
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ARF: Onset
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*begins with insult and ends with oliguria
*the key is prevention *monitor BP (if low for them, kidney perfusion <, CR^) *monitor vol status: (I&O) *monitor cardiac func: (If pulse <, < function) *monitor labs: (BUN,Cr^= not a good sign) *identify potential nephotoxins (NSAIDS) |
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ARF: Oliguric phase
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*can last up to 8 weeks
*vol overloaded pt: edema, crackles, rales, ^HR, SOB (d/t <UO) *lab values altered (^BUN,Cr, ^K, dilutional hyponatremia, <Ca, ^Phos, <H&H) *Acidosis (metabolic-kidney can't get rid of bicarb) *diet changes (restrict proteins, ^CHO, ^fats *Tx: low dose dopamine (^perfusion, ^BP, ^vasodilation) |
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ARF: Diuresis Phase
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*^UOn (^out d/t lasix, bumex or renal cocktail)
*FVD (I&O) *Labs: (<Cr, <K, ^H&H, ^Ca, <Phos |
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ARF: Recovery phase
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*lasts about six months
*Primary concerns: maintain UO, Monitor I&O, BP, drugs they are on |
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S/S of ARF
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*CNS (lethargy, confusion, tremors, seizures, coma)
*CV: EKG changes, tachycardia, edema (caused by ^K, bradycardia to asystole) *PULM: SOB, rales, frothy sputum with CHF, rapid resp (too much vol = ^rr/acidosis) *GI: n/v/d (build up of waste) *GU: urine scant, cloudy, sediment |
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ARF: Laboratory Data
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*^BUN
*^Cr *ABG: <CO2, <ph, <HCO3, <PO2 *^K *^Phos *<Ca *<RBC & Hgb |
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ARF: Treatment
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*correct cause
*manage volume status (^vol=^wt, but still <BP= give albumin, then lasix) *correct elec. imbal. *correct acidosis (can give bicarb) *treat azotemia: dialysis *nutritional requirements (<proteins, ^CHO, fat) *stimulate kidneys: drugs |